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Chemotherapy for Cervical Cancer

  • Romelie Rieu
  • Gemma Eminowicz
Chapter

Abstract

Chemotherapy has a potential role in all stages of cervical cancer. Chemotherapy can be administered in the neoadjuvant, concurrent with radiation, adjuvant and palliative setting. Randomised evidence has clearly established the role of chemotherapy for uterine cervical cancer in the concurrent with radiation and metastatic/palliative settings.

The exact role of neoadjuvant chemotherapy preoperatively in early stage disease or pre-chemo-radiation in locally advanced disease has not yet been proven and is currently under investigation in the EORTC 55994 and INTERLACE trial, respectively. Neoadjuvant chemotherapy is also appealing to reduce tumour bulk and enable fertility-sparing surgical management and warrants further investigation. During radiation for locally advanced cervical cancer, the addition of chemotherapy significantly improves survival and is therefore an established standard of care. Weekly cisplatin chemotherapy is the most commonly used regimen, but a variety of regimens are used worldwide. Adjuvant chemotherapy after chemo-radiation in theory could improve survival but is unproven and is therefore being investigated within the OUTBACK study. In the metastatic or inoperable recurrent setting, the majority of patients will be managed with combination chemotherapy, e.g. carboplatin or cisplatin with paclitaxel, if fitness allows. The addition of bevacizumab to this combination significantly improves survival and is approved in many countries as first-line treatment if patients are fit enough. Second-line treatment is less evidence-based with commonly used regimens including single-agent carboplatin, single-agent paclitaxel often administered weekly, topotecan and others. In general, if patients are fit at the time of needing second-line treatment, referral to specialist trial units for phase I/II trial is recommended.

Neuroendocrine (i.e. small-cell) tumours are a rare histological subtype of uterine cervical cancer accounting for approximately 2% of all cervical cancer diagnoses. This subtype is more chemosensitive, and management is therefore similar to that for small-cell lung cancer. The use of cisplatin and etoposide chemotherapy is therefore critical in the management of all stages of disease. This chapter discusses the evidence available and current trials in all of these settings to clarify the important role of chemotherapy in uterine cervical cancer.

Keywords

Cervical cancer Concurrent chemotherapy Neoadjuvant chemotherapy Cisplatin Palliative chemotherapy Adjuvant chemotherapy 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical Oncology/Radiotherapy, Charing Cross HospitalImperial College Healthcare NHS TrustLondonUK
  2. 2.Department of Clinical Oncology/Radiotherapy, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK

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